Yours Toothfully by Dr Chan Joon Yee

A person who sounded like an expert confidently declared that the economy is recovering. That’s because he has noticed that ordinary folks in T-shirts and bermudas are flocking to new property launches like a Singapore Idol audition. In the same breath, the expert thinks that dentists are not affected by economic downturns. He’s not alone. Many of my friends are surprised that dentists’ incomes are affected by a recession because they are still under the impression that dentists treat toothaches and nothing else.

Sure, dentists are trained to extract or fill up painful teeth, but how often do people have toothaches and need extractions? In fact, most progressive practices today do very few extractions. Even when a tooth is dead and infected, the treatment of choice is root canal. Educated, cooperative and motivated patients are expected to turn up regularly for hygiene visits even when they do not have any toothache. In the developed world, preventive dentistry (scaling, polishing, filling early cavities, mouthguards, removing impacted wisdom teeth) keeps many general practices busy. Yet, we often see people walking around with teeth encrusted with barnacles, oozing with plaque and bad breath. From the dentist’s point of view, it is extremely important that patients clean up the tartar on their teeth and arrest any early gum disease. From the average Singaporean’s point of view, it’s: no pain, no need to see dentist.

What else do dentists do? There is denture construction, crown and bridge work, implant dentistry. Again, in the developed world, people change their dentures every few years. They do crowns and bridges to restore broken or missing teeth. They also go for dental implants. All these procedures come under the field of restorative dentistry. From the dentist’s point of view, most people who have lost some teeth will require restorative dental treatment. It restores the person’s smile and function. However, we often see people walking around with missing teeth. Those who have lost back teeth often don’t bother to replace them, resulting in the remaining teeth drifting everywhere. From these people’s point of view, restorative dentistry is not necessary. Why? No pain, no need to see dentist.

A combination of preventive and restorative dentistry form thee bulk of the average general dental practitioner’s income. Both fields of dentistry can be rather recession prone. Take implant restoration for instance. An economic downturn of this magnitude will have a very drastic impact on patient acceptance of procedures like implants, crowns and bridges. For many practitioners who have upgraded themselves and acquired new skills to perform sophisticated procedures, the bulk of their income will come from these procedures and the handling of nasty toothaches. Tooth whitening and other cosmetic dental procedures form the bulk of treatment rendered in many upmarket practices.

But the “experts” are right in thinking that someone suffering from the intense pain of acute pulpitis will not hesitate to see a dentist regardless of economic situation. By the same token, they should also realise that only a nasty toothache will force a person to see a dentist regardless of economic climate. While it’s good that dentists are doing more root canals, more preventive and restorative treatment, these treatments may end up working against dentists by reducing the number of toothaches in a population which still cannot accept preventive dentistry as a necessity.

If you’re looking garbage, you’d be wise to check out the dump. If you’re looking trouble, a reliable blacklist should tell you who to contact if you relish a good fight. But almost nobody deliberately looks for garbage and trouble. Very often, these things look for us - in the form of alamak patients. So how do I tell if a patient may be difficult?

She walked in a couple of months ago with a broken molar tooth on which root canal has already been completed at a clinic at Mt E. I asked her why she didn’t have it crowned. She said that the dentist there refused to do the crown for her. The alarm bells should have rung loud enough for me to send her off, but I decided to be sympathetic and took over the case.

Probably feeling thankful that someone was willing to work on her case, she started asking for other root canals and even a bridge. I did the necessary root canals, extraction, temporary bridge and finally, this morning, I cemented her e.max bridge. She complained about sensitivity over 2 unrelated teeth, so I replaced the old fillings for her.

She walked out after the treatment, paid for the bridge (whew!), but refused to pay for the fillings. I explained that the two fillings were not a part of the initial treatment agreed upon. She got aggressive and accused me of spoiling her teeth with the bridge! She insisted that she never had this problem before the bridge was done, but the two teeth that were filled were not even part of the bridge.

My mind went back to her first visit when she told me that the dentist at Mt E had refused to do the crown for her. Why? Probably because she accused him/her or spoiling her tooth with the root canal to make sure that she would need to do a crown.

What did I do? I waived the additional charges and quietly told my assistant to give her excuses not to see her again if she ever called up. It’s never a good idea to work with someone who doesn’t trust you. Anyway, she’ll probably go to the next dentist and talk about this rotten guy at Lucky Plaza who refused to attend to her after doing her bridge. I hope that will ring the alarm bells for the next guy.

Oh no. Headahe dentistry all over again? Nah! Just the odd one every now and then. Working at Orchard only has been a lot less stressful. It would be good if we dentists can keep a blacklist like some of our colleagues in America. Then, we’ll know where to find trouble and how to avoid it.